Welcome to Washington Apple Health Integrated Managed …[Romanian] Serviciile de asistență lingvistică, inclusiv cele de interpretariat și de traducere a materialelor imprimate,

Welcome to Washington Apple Health

Managed Care

2HCA 65-153 (3/17)

[English] Language assistance services, including interpreters and translation of printed materials, are available free of charge. Call 1-800-562-3022 (TRS: 711).

[Amharic] የቋንቋ እገዛ አገልግሎት፣ አስተርጓሚ እና የሰነዶችን ትርጉም ጨምሮ በነጻ ይገኛል፡፡ 1-800-562-3022 (TRS: 711) ይደውሉ፡፡

[Arabic] خدمات المساعدة في اللغات، بما في ذلك المترجمین الفوریین وترجمة المواد المطبوعة، متوفرة مجاناً، اتصل على رقم

3022-562-800-1 )TRS: 711.(

[Burmese] ဘာသာျပန္ဆုိသူမ်ားႏွင့္ ထုတ္ျပန္ထားသည့္

စာရြက္စာတမ္းမ်ားဘာသာျပန္ျခင္းအပါအဝင္

ဘာသာစကားအေထာက္အကူဝန္ေဆာင္မႈမ်ားကုိ အခမဲ့ရႏိုင္ပါသည္။

1-800-562-3022 (TRS: 711) ကုိဖုန္းေခၚဆုိပါ။

[Cambodian] esvaCMnYyPasa rYmmanTaMg/ñkbkE®bpÊal'mat' nig

karbkE®bGksare◊HBumı KW/acrk◊neday≤tKit´z¬.

ehATUrs¤BÊeTAelx 1-800-562-3022 (TRS: 711).

[Chinese] 免费提供语言协助服务，包括口译员和印制资料翻译。请致电 1-800-562-3022 (TRS: 711)。

[Korean] 통역 서비스와 인쇄 자료 번역을 포함한 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-800-562-3022 (TRS: 711)번으로 전화하십시오.

[Laotian] kanbMrikand™anfaSa, lvmtzgnaYEpfaSa ElA kanEpewk San†Ifim, mIRv™VH™FrIodYbB̊ id Æ̊a. otHaelk 1-800-562-3022 (TRS: 711).

[Oromo] Tajajilli gargaarsa afaanii, nama afaan hiikuu fi ragaalee maxxanfaman hiikuun, kaffaltii malee ni argattu. 1-800-562-3022 (TRS: 711) irratti bilbilaa.

[Persian] خدمات کمک زبانی، از جملھ مترجم شفاھی و ترجمھ اسناد و مدارک (مطالب) چاپی، بصورت رایگان ارائھ خواھد شد.با شماره

1-800-562-3022 (TRS: 711) .تماس بگیرید

[Punjabi] ਭਾਸਾਾ ਸਾਾਇਾਾ ਸੇਾੇਵ—ਦੁਭਾਸ਼ੀਾ ਇਸਾ ਿਪ� ੰਾਕ਼ਇ਼ਾਸੋਈਾ

ਮੱਗਰ਼ਾਦਸਾ � ਨੁੇਾਦਾ ਮਸਇ—ਮੁਫ਼ਇਾਉਿਲੱਬਧਾਸਨ।ਾ1-800-562-3022

(TRS: 711) 'ਇਸਾਕਾਲਾਕਰੋ।ਾ

[Romanian] Serviciile de asistență lingvistică, inclusiv cele de interpretariat și de traducere a materialelor imprimate, sunt disponibile gratuit. Apelați 1-800-562-3022 (TRS: 711).

[Russian] Языковая поддержка, в том числе услуги переводчиков и перевод печатных материалов, доступна бесплатно. Позвоните по номеру 1-800-562-3022 (TRS: 711).

[Somali] Adeego caawimaad luuqada ah, ay ku jirto turjubaano afka ah iyo turjumid lagu sameeyo waraaqaha la daabaco, ayaa lagu helayaa lacag la’aan. Wac 1-800-562-3022 (TRS: 711).

[Spanish] Hay servicios de asistencia con idiomas, incluyendo intérpretes y traducción de materiales impresos, disponibles sin costo. Llame al 1-800-562-3022 (TRS: 711).

[Swahili] Huduma za msaada wa lugha, ikiwa ni pamoja na wakalimani na tafsiri ya nyaraka zilizochapishwa, zinapatikana bure bila ya malipo. Piga 1-800-562-3022 (TRS: 711).

[Tagalog] Mga serbisyong tulong sa wika, kabilang ang mga tagapagsalin at pagsasalin ng nakalimbag na mga kagamitan, ay magagamit ng walang bayad. Tumawag sa 1-800-562-3022 (TRS: 711).

[Tigrigna] ተርጎምትን ናይ ዝተፅሓፉ ማተርያላት ትርጉምን ሓዊሱ ናይ ቋንቋ ሓገዝ ግልጋሎት፤ ብዘይ ምንም ክፍሊት ይርከቡ፡፡ ብ 1-800-562-3022 (TRS: 711) ደውል፡፡

[Ukrainian] Мовна підтримка, у тому числі послуги перекладачів та переклад друкованих матеріалів, доступна безкоштовно. Зателефонуйте за номером 1-800-562-3022 (TRS: 711).

[Vietnamese] Các dịch vụ trợ giúp ngôn ngữ, bao gồm thông dịch viên và bản dịch tài liệu in, hiện có miễn phí. Gọi 1-800-562-3022 (TRS: 711).

HCA 65-153 (3/17)




3022-562-800-1 )TRS: 711.(













1-800-562-3022 (TRS: 711) .تماس بگیرید













HCA 65-153 (3/17)




3022-562-800-1 )TRS: 711.(













1-800-562-3022 (TRS: 711) .تماس بگیرید













HCA 65-153 (3/17)




3022-562-800-1 )TRS: 711.(













1-800-562-3022 (TRS: 711) .تماس بگیرید













HCA 65-153 (3/17)




3022-562-800-1 )TRS: 711.(













1-800-562-3022 (TRS: 711) .تماس بگیرید













HCA 65-153 (3/17)




3022-562-800-1 )TRS: 711.(













1-800-562-3022 (TRS: 711) .تماس بگیرید













HCA 65-153 (3/17)




3022-562-800-1 )TRS: 711.(













1-800-562-3022 (TRS: 711) .تماس بگیرید













HCA 65-153 (3/17)




3022-562-800-1 )TRS: 711.(













1-800-562-3022 (TRS: 711) .تماس بگیرید













HCA 65-153 (3/17)




3022-562-800-1 )TRS: 711.(













1-800-562-3022 (TRS: 711) .تماس بگیرید













HCA is committed to providing equal access to our services. If you need an accommodation, or require documents in another format or language, please call 1-800-562-3022 (TRS: 711).

3

Table of Contents

Welcome to Washington Apple Health [4]

Apple Health services [4]

Your services card [5]

Managed care service area map and matrix [7-8]

Health services (Primary care) [9]

Behavioral health services [10]

Information for American Indians and Alaska Natives [12]

Ombuds [13]

Services you may need to access health care [14]

Your rights & responsibilities [16]

Contact us/resources [17]

Disclaimer about this booklet:

This booklet will introduce you to your benefits and explain your rights and responsibilities, how to access services, and how to change health plans. Please be advised this booklet does not create any legal rights or entitlements. You should not rely on this booklet as your only source of information about Apple Health (Medicaid). You can get detailed information about Apple Health by looking at the Health Care Authority website on the Laws and Rules page, hca.wa.gov/about-hca/rulemaking.

www.hca.wa.gov/about-hca/rulemaking

4

Welcome to Washington Apple HealthYou are receiving this booklet because you recently enrolled in Washington Apple Health (Medicaid). The Washington State Health Care Authority (HCA) administers Apple Health and contracts with managed care plans to provide your coverage. Later you will receive “Your Benefits Handbook” from your health plan. It will provide more detail about your covered benefits.

Apple Health services from your plan

Your Apple Health managed care health plan covers the following services:• Appointments with a doctor or health care professional

for necessary care including preventive and wellness services, and chronic disease management

• Medical care in an emergency

• Maternity and newborn care

• Pediatric services, including oral and vision care

• Laboratory services

• Prescription drugs

• Hospitalization

• Ambulatory patient services

• Rehabilitative and habilitative* services and devices

• Mental health services

• Substance use disorder treatment services

*Contact your health plan to see if you are eligible

Note: This list is for general information only and does not guarantee Apple Health will cover the service.

Contact your health plan’s member services number when you (or your child):

Have a problem or concern with your health plan.

Need to find a primary care provider.Want to change your primary care

provider (PCP). Lose your health plan ID card and want

another one.

Have a special health care need (or your child does).

Need access to mental health services.Need access to substance use disorder

treatment services.

5

Your services card

You will receive two cards in the mail, one from Washington Apple Health (the services card) and one from the health plan that will manage your care.

About two weeks after you enroll in Washington Apple Health through Washington Healthplanfinder wahealthplanfinder.org or Washington Connection washingtonconnection.org you will receive a blue services card (also called a ProviderOne card) like the one pictured here. Keep this card. Your services card shows you are enrolled in Apple Health.

You do not have to activate your new services card. HCA will activate your card before we mail it to you.

If you don’t get your services card or you lose it

If you don’t get your services card by the end of two weeks after successfully completing your Apple Health enrollment or if you lose your card, you can request a replacement card:

• WAPlanfinder app: If you have a Washington Healthplanfinder account, you can access your digital services card in the WAPlanfinder app, available in the Apple App store or Google Play.

• Online client portal: https://www.waproviderone.org/client

• Call: 1-800-562-3022 (toll free) and choose option 1 for self-service, then option 1 for services card.

Your health plan

You will receive a letter listing the name of your health plan. You have the right to request to change your health plan at any time. For more information on how to change plans see “Changing health plans” on page 6.

If one or more of the following situations applies to you, call us right away at 1-800-562-3022 (TRS: 711):

• You become eligible for Medicare or private insurance.

• You are American Indian or Alaska Native. You can consider an option other than coverage through a managed care plan.

• You are enrolled or choose to enroll in Washington’s Program of All-Inclusive Care for the Elderly (PACE).

• You have a verifiable medical condition, and changing providers or health plans would interrupt your treatment and place your health at risk.

Your health plan card

Health Plan (80840) 911-87726-04Member ID: Group Number:

0501

Payer ID:

Rx Bin: 610494Rx GRP: ACUWARx PCN: 9999

Apple Health - Family CoverageAdministered by UnitedHealthcare of Washington, Inc.

000000000 WAHLOPMember:MEMBER NAME

PCP Name:PROVIDER NAMEPCP Phone: (000)000-0000

PROVIDER ADDRESSCITY, STATE, ZIP

87726

03115 9936462 0000 0000005 0000005 178 2 11303115 9936462 0000 0000005 0000005 178 2 113

RUN_DATE 20180627 13:01:01DATA_SEQ_NO 0000001CLIENT_NUMBER 003115UHG_TYPE DIG1SHRTDOC_ID DOC_SEQ_ID 0000005NAME ENGLISH ,REISSUEMAILSET_NUMBER 0000005CUSTCSP_KEY1 000200026000200026_KEY0 CARD1CUSTCSP_KEY2 WAHLOPCUSTCSP_KEY3 REISSUECUSTCSP_KEY4 HCAC/MedicalCUSTCSP_KEY5 00CUSTCSP_KEY6 00000000CUSTCSP_KEY7 000200026~00CARD1CUSTCSP_KEY8 000200026CUSTCSP_KEY9 000200026~00CARD1

In an emergency go to nearest emergency room or call 911. Printed: 06/27/18

This card does not guarantee coverage. To verify benefits or to find a provider, visit the website myuhc.com/communityplan or call.

For Members: 877-542-8997 TTY 711NurseLine: 877-543-3409 TTY 711

For Providers: www.uhccommunityplan.com 877-542-9231Medical Claims: PO Box 31361, Salt Lake City, UT 84131-0361

Pharmacy Claims: OptumRX, PO Box 29044, Hot Springs, AR 71903For Pharmacists: 877-305-8952

Shipper ID: 00000000 Insert #1 Insert #2 Shipping Method: DIRECT Insert #3 Insert #4 CARRIER: USPS Insert #5 Insert #6 Address: Insert #7 Insert #8 REISSUE ENGLISH Insert #9 Insert #10 124 ANY STREET Insert #11 Insert #12 ANYTOWN, WA 99999-9999

Cycle Date: 20180627PDF Date: Wed Jun 27, 2018 @ 13:01:01

MaxMover: YMailing/Meter Date: UHG JOB ID: 8903 GRP: WAHLOP PV: RC: MKT: 77777

MT: 00 SA: 00 OI: 97 FORM: K2H000 CPAY: DALE BROWN: NO LETTER NM: LETTER2 DIVISION : CARD TYPE: BF

TEMPLATE: NEW FAMILY/IND : STD IND : STANDARD : STANDARD

Managed care plan contacts Main phone Website

Amerigroup (AMG) 1-800-600-4441 myamerigroup.com/wa

Community Health Plan of Washington (CHPW) 1-800-440-1561 chpw.org

Coordinated Care of Washington (CCW) 1-877-644-4613 coordinatedcarehealth.com

Molina Healthcare of Washington (MHW) 1-800-869-7165 molinahealthcare.com

United Healthcare Community Plan (UHC) 1-877-542-8997 uhccommunityplan.com

www.wahealthplanfinder.orgwww.washingtonconnection.orgwww.myamerigroup.com/wawww.chpw.orgwww.coordinatedcarehealth.comwww.molinahealthcare.comwww.uhccommunityplan.com

6

Your health plan card

A few weeks after you enroll in Apple Health, you will receive a health plan ID card, as well as more information from your plan about how to choose a doctor or primary care provider (PCP). Keep this card, too! Take both your services card and your health plan ID card with you when you go to a doctor, pharmacy, or other health care providers. You may also need a photo ID.

Changing health plansYou have the right to request to change your health plan at any time. Depending on when you make your request, your new plan will usually start the first of the next month. There are several ways to switch your plan:

• Apple Health clients with a Washington Healthplanfinder account can change plans anytime online at wahealthplanfinder.org.

• For all Apple Health clients, visit the ProviderOne Client Portal website https://www.waproviderone.org/client.

• Request a change online at https://fortress.wa.gov/hca/p1contactus/. Choose “Client” and select the topic “Enroll/Change Health Plans”

• Call Apple Health Customer Service at 1-800-562-3022. Our automated system is available 24 hours a day, 7 days a week.

There is a plan comparison table in this booklet showing health plan quality measures and scores. You can use the scores to help you decide which health plan is best for you. You will also find a description of the measures, and why receiving this care is important for you or your family member’s health.

If you need health care services before your cards arrive You will receive a letter that tells you your health plan. If you need to go to a health care provider or fill a prescription before your cards arrive, take your eligibility decision letter with you to the health care provider or pharmacy. You can go to any doctor, health clinic, behavioral health provider, or pharmacy, as long as the provider is in your plan’s network (contracted with your health plan). Contact your health plan for a list of providers.

You can also call your health plan for help, even if you have not received your services card or health plan ID card.

ProviderOne

You’ll see “ProviderOne” on your services card. ProviderOne is the information system that coordinates the health plans for us and helps us send you information at various times. The number on the card is your ProviderOne client number, (nine-digits ending in WA). You can look online to check that your enrollment has started in your health plan through the ProviderOne Client Portal at https://www.waproviderone.org/client . Health care providers can also use ProviderOne to see whether their patients are enrolled in Apple Health.

Each member of your household who is eligible for Apple Health will receive their own services card. Each person has a different ProviderOne client number that stays with them for life.

If you had previous Apple Health coverage, you won’t be mailed a new card. Your old card is still valid, even if there is a gap in coverage. Your ProviderOne client number remains the same.

www.wahealthplanfinder.orghttps://www.waproviderone.org/clienthttps://fortress.wa.gov/hca/p1contactus/

7

Washington Apple Health (Medicaid) offers integrated managed care, also referred to as whole-person care. With integrated managed care, an Apple Health

What is managed care?managed care plan coordinates and pays for both your physical and behavioral health services. (Behavioral health services include mental health and substance use disorder treatment services.)

Apple Health managed care service area map

Apple Health managed care Service area map - January 2021

Pierce

North Sound

King

GreaterColumbia

Spokane

AMG – Amerigroup WashingtonCCW – Coordinated Care of WashingtonCHPW – Community Health Plan of WashingtonMHW – Molina Healthcare of WashingtonUHC – UnitedHealthcare Community Plan

Integrated managed care regions Health plans o�ered

North Central

Southwest Washington

Apple Health Foster Care is a statewide program. Integrated managed care is provided through Apple Health Core Connections (Coordinated Care of Washington - CCW).

HCA 19-0036 (10/20)

Thurston-Mason

Salish

Great Rivers

Apple Health Foster Care (statewide)

Adams

Skamania

Klickitat

Yakima

Kittitas

Chelan

Douglas

Grant

Benton

Franklin

Lincoln Spokane

Stevens PendOreilleFerry

Whitman

Walla Walla

Columbia

Gar�eld

Asotin

Clark

Okanogan

Island

San Juan

Snohomish

Paci�c Lewis

Thurston

Cowlitz

Paci�c Lewis

CowlitzWahkiakumWahkiakum

Je�erson

Kitsap

SpokaneAMG

CHPWMHW

North CentralAMG CCW CHPW MHW

Greater ColumbiaAMG CCW CHPW MHW

KingAMG MHW CCW UHCCHPW

Pierce

SouthwestAMG CCW CHPW MHW

NorthSound

AMGCCW

CHPWMHWUHC

PierceKing

Whatcom

Skagit

SalishAMG MHW UHC

Grays Harbor

Thurston-Mason

AMGMHWUHC

Great Rivers AMG MHW UHC

NorthSound

AMGCCW

CHPWMHWUHCClallam

AMG CCW CHPWMHW UHC

Island

San Juan

8

Apple Health managed care service area matrix

Note: Apple Health Foster Care is a statewide program, provided through Apple Health Core Connections (Coordinated Care of Washington).

County Amerigroup Community Health PlanCoordinated

CareMolina

HealthcareUnited

HealthcareAdams X X XAsotin X X X XBenton X X X XChelan X X X XClallam X X XClark X X X XColumbia X X X XCowlitz X X XDouglas X X X XFerry X X XFranklin X X X XGarfield X X X XGrant X X X XGrays Harbor X X XIsland X X X X XJefferson X X XKing X X X X XKitsap X X XKittitas X X X XKlickitat X X X XLewis X X XLincoln X X XMason X X XOkanogan X X X XPacific X X XPend Oreille X X XPierce X X X X XSan Juan X X X X XSkagit X X X X XSkamania X X X XSnohomish X X X X XSpokane X X XStevens X X XThurston X X XWahkiakum X X XWalla Walla X X X XWhatcom X X X X XWhitman X X X XYakima X X X XFoster Care (statewide) X

Apple Health managed careService area matrix - January 2021

HCA 19-0038 (10/20)

9

Choosing a primary care provider

It’s important to choose a primary care provider (PCP). If you don’t choose a PCP, your health plan will choose one for you. Your PCP is the main health professional you see. They will become familiar with your health history, current health issues, and can refer you to specialists. Having a dedicated PCP makes it easier to take care of your health.

To choose a PCP, follow the directions sent to you by your health plan, or call your health plan’s member services phone number. You can also choose a PCP through your health plan’s website.

If the PCP you want is not in your health plan’s network, ask which health plan they work with. You have the right to change health plans.

You can specify what gender you would prefer for your PCP. You can also ask for a provider who speaks your language, specializes in your disability, or understands your culture.

Your PCP should be someone you feel comfortable with. If you aren’t happy with your PCP for any reason, call your plan’s member services phone line at any time to change to another provider.

Routine care Make an appointment with your PCP. You should be able to make an office visit with your PCP or another provider within 10 days.

Preventive care Make an appointment with your PCP or other provider. You should be able to get an appointment within 30 days.

Specialty care Call your health plan or PCP.

Mental Health Call your health plan or PCP.

Substance use disorder treatment services

Call your health plan or PCP.

For after-hours care Call your health plan’s nurse advice line 24 hours a day, seven days per week.

For urgent care Go to an urgent care center that contracts with your health plan, or call your PCP or the nurse advice line. You should be able to visit with your PCP or other provider within 24 hours.

For emergency care Call 911 or go to the nearest place where emergency providers can help. As soon as possible, you or someone you know must call your PCP or your health plan to report your emergency.

For care away from home

If it is not an emergency, call your PCP or the nurse advice line, listed on your plan ID card.

If you already have a primary care providerIf you are already seeing a PCP you like, or have heard about a provider you want to try, you can ask for that provider. However, your PCP has to be part of your health plan’s network (contracted with your health plan).

If the provider you want is not in your health plan’s network, ask the provider which health plan they work with.

How to make an appointmentOnce you have selected a PCP, call to make an appointment. You must have an appointment to see a PCP. If you have immediate health concerns or needs, you should be able to see your PCP within a few days. Even if you don’t have immediate health concerns, make an appointment for a general check-up (also called a wellness check). It will usually take longer to get an appointment for a general check-up, so don’t put it off.

10

Behavioral health services

If you’re enrolled in Apple Health, you have access to mental health and substance use disorder treatment services (together known as behavioral health services). Behavioral health services are included in your integrated managed care plan benefit package. The benefits have not changed. The only change is the integrated managed care plan will cover these services instead of a regional Behavioral Health Organization.

Contact your health plan or primary care provider if you need help coordinating your care.

Substance use disorder treatment services

may include: Assessment – An “interview” by a health provider to decide the services you need.

Brief Intervention Treatment – Time limited, to reduce problem use. You do not need an outpatient intake evaluation before this service.

Withdrawal Management (Detoxification) – Help with decreasing your use of alcohol or other drugs over time, until it is safe to stop using. You do not need an outpatient intake evaluation before this service.

Outpatient Treatment – individual and group counseling sessions in your community.

Intensive Outpatient Treatment – More frequent individual and group counseling sessions.

Inpatient Residential Treatment – A comprehensive program of individual counseling, group counseling, and education provided in a 24-hour-a-day supervised facility.

Opiate Substitution Treatment Services – Provides outpatient assessment and treatment for opiate dependency. Includes approved medication and counseling.

Case Management – Help with finding medical, social, education, and other services.

11

Evaluation and Treatment/Community Hospitalization – Medically necessary inpatient crisis care. You do not need an outpatient intake evaluation before this service.

Stabilization Services – Provided in your home or home-like setting to help prevent a hospital stay. You do not need an intake evaluation before this service.

Rehabilitation Case Management – Coordination between your inpatient and outpatient mental health services. You do not need an outpatient intake evaluation before this service.

Mental Health Services Provided in Residential Settings – Services provided where you live if you live in a group setting.

Special Population Evaluation – Treatment planning assistance from a specialist who works with special populations, such as children, older adults, or individuals from other cultural backgrounds.

Psychological Assessment – Testing that helps with diagnosis, evaluation, and treatment planning.

Crisis services

Crisis services are 24-hour services intended to stabilize you if you are in crisis, provided in a location that is best suited to meet your needs. You do not need an intake evaluation for these services.

• For immediate help, call 911 or go to the nearest hospital emergency room. You do not need an authorization for crisis services.

• For a State Crisis Lines directory, visit: hca.wa.gov/mental-health-crisis-lines.

• Washington Recovery Help Line is a 24-hour crisis intervention and referral line for those struggling with issues related to mental health, substance abuse, and problem gambling. Call 1-866-789-1511 (TTY 206-461-3219); email [email protected], or visit warecoveryhelpline.org. Teens can connect with teens during specific hours: call 1-866-833-6546, email [email protected], or visit 866teenlink.org.

• For the National Suicide Prevention Lifeline: call 1-800-273-8255 (TTY users 1-800-799-4889).

Mental health services may include:

Intake Evaluation – Identifies your needs and goals and helps your mental health care provider recommend other services and plan treatment.

Individual Treatment Services – Counseling and/or other activities designed to meet the goals in your service plan.

Medication Management – Licensed staff prescribing medicine and talking to you about side effects.

Medication Monitoring – Services to check on how your medication is working and to help you to take it correctly.

Group Treatment Services – Counseling with others who have similar challenges.

Peer Support – Help with navigating the mental health system and reaching your recovery goals, provided by a trained person who has similar challenges.

Brief Intervention and Treatment – Short-term counseling focused on a specific problem.

Family Treatment – Family-centered counseling to help build stronger relationships and solve problems.

High Intensity Treatment – Services provided by a team of mental health providers to help you meet the goals in your service plan.

Therapeutic Psychoeducation – Education about mental illness, mental health treatment choices, medications and recovery, including supports and/or supportive services.

Day Support – Intensive program to learn or assist with independent living skills.

www.hca.wa.gov/mental-health-crisis-lineswww.warecoveryhelpline.orgwww.866teenlink.org

12

Information for American Indians and Alaska NativesIf you are American Indian or Alaska Native, you may be able to get health care services through an Indian Health Service (IHS) facility, tribal health care program or Urban Indian Health Program (UIHP) such as the Seattle Indian Health Board or NATIVE Project of Spokane. The providers at these clinics know your culture, community, and health care needs.

They will give you the care you need or refer you to a specialist. They may also help you with decisions you need to make about whether to choose a managed care plan, (which may be a Behavioral Health Services Only [BHSO] plan), or Apple Health coverage without a managed care plan (this is also called Apple Health fee-for-service). If you have questions about your health care or your health carecoverage, your tribal or UIHP staff may be able to help you.

Ways to receive health care

HCA gives American Indians and Alaska Natives in Washington a choice between Apple Health managed care or Apple Health coverage without a managed care plan. HCA does this to comply with federal rules, in recognition of the complexity of the Indian health care delivery system, and to help ensure that you have access to culturally appropriate health care.

• In Apple Health coverage without a managed care plan, you may choose any provider who participates in the Apple Health fee-for-service program and currently accepts patients. These providers must meet all requirements of their state-issued licenses. To find an Apple Health fee-for-service health provider, visit https://fortress.wa.gov/hca/p1findaprovider/

• With Apple Health managed care, your health care is managed by a managed care organization (MCO). This means that the MCO serves as your single point of contact to get services and helps coordinate your care.

This choice can make sense if your care is already being managed, such as by a tribal health program or UIHP.

This choice can make sense if you do not have anyone managing your care.

You can change your selection(s) at any time, but the change will not take effect until the next available month. If you are connected or partnered with a Tribal Assister through an IHS facility, Tribal health program or UIHP, they can help you make your decision. You can also contact the Health Care Authority at 1-800-562-3022 to let us know of your choice(s), including any change you wish to make, and to ask questions.

13

Ombuds

An Ombuds is a person who is an available option to provide free and confidential assistance with resolving concerns related to your behavioral health services. They can help if you have a behavioral health grievance, appeal, or fair hearing to resolve your concerns at the lowest possible level. The Ombuds is independent of your health plan. It is provided by a person, or a person whose family member, has had behavioral health services.

Region Counties Phone numbers

Great Rivers Cowlitz, Grays Harbor, Lewis, Pacific, Wahkiakum

1-833-721-6011

Greater Columbia Asotin, Benton, Columbia, Franklin, Garfield, Kittitas, Walla Walla, Whitman, Yakima

1-833-783-9444or1-509-783-9444

King King 1-800-790-8049 (#3)or1-206-477-0630

North Central Chelan, Douglas, Grant, Okanogan

1-844-636-2038

North Sound Island, San Juan, Skagit, Snohomish, Whatcom

1-888-336-6164or1-360-416-7004

Pierce Pierce 1-800-531-0508

Salish Clallam, Jefferson, Kitsap 1-888-377-8174or1-360-692-1582

Spokane Adams, Ferry, Lincoln, Pend Oreille, Spokane, Stevens

1-866-814-3409or1-509-477-4666

Southwest Clark, Klickitat, Skamania 1-800-696-1401

Thurston-Mason Mason, Thurston 1-800-658-4105or1-360-763-5793

14

If you have a disabilityIf you have a speech or hearing disability or a mobility issue, you should tell the receptionist when you make your appointment. The receptionist will help you make any necessary arrangements.

If you are Deaf, DeafBlind, or Hard of Hearing, and need a sign language interpreter, please let the receptionist know. A professional interpreter is available, at no cost to you.

You can get help with transportationYou may be eligible for help with transportation to your health care appointment at no cost to you. The appointment must be for services covered by Apple Health. The most common types of transportation available include: public bus, gas vouchers, client and volunteer mileage reimbursement, volunteer drivers, taxi, wheelchair van or accessible vehicle, and commercial bus and air. A list of brokers can be found at hca.wa.gov/transportation-help.

Services covered by Apple Health without a managed care plan

Apple Health coverage without a managed care plan (also known as fee-for-service) covers certain benefits and services even when you are enrolled in an Apple Health managed care health plan. Some of these benefits include:

• Long-term services and support.• Services for individuals with developmental disabilities.• Dental services.• Eyeglasses and fitting services for children (under age 21).• Maternity support services, prenatal genetic counseling,

and pregnancy termination.

If you have a question about a benefit or service not listed here call Apple Health Customer Service at 1-800-562-3022.

Services you may need to access health care

You might need an interpreterIf you don’t speak English well or you are Deaf, DeafBlind, or Hard of Hearing, professional interpreters are available in many languages, including sign language, at no cost to you. When you make a health care appointment, let the receptionist know if you need an interpreter. Spoken language interpreters can go to the provider’s office or be on the phone during your appointment. Sign language interpreters can go to the provider’s office if you are Deaf, DeafBlind, or Hard of Hearing.

It’s better to use one of these professional interpreters than to bring a family member or friend to interpret for you. The interpreters are trained to understand health care terms. They will help you and your provider understand each other. Learn more at hca.wa.gov/interpreter-services.

www.hca.wa.gov/transportation-helpwww.hca.wa.gov/interpreter-services

15

2020 Washington Apple Health Plan Report Card

This report card shows how Washington Apple Health plans compare to each other in key performance areas. You can use this report card to help guide your selection of a plan that works best for you.

KEY: Performance compared to all Apple Health plans

Above average

Average

Below average

These ratings were based on information collected from health plans in 2019.

The information was reviewed for accuracy by independent auditors.

Health plan performance scores were not adjusted for differences in their member populations or service regions.

HCA 19-057 (9/20)

Performance area definitionsGetting care• Members have access to a doctor• Members report they get the care they need,

when they need it

Keeping kids healthy• Children in the plan get regular checkups• Children get important immunizations• Children get the appropriate level of care

when they are sick

Keeping women and mothers healthy• Women get important health screenings, such

as cervical cancer screenings• New and expecting mothers get the care they need

Preventing and managing illness• The plan helps its members keep long-lasting illness

under control, such as asthma, high blood pressure or diabetes

• The plan helps prevent illnesses with screenings and appropriate care

Ensuring appropriate care• Members receive the most appropriate care and

treatment for their condition

Satisfaction with care provided to children• Members report high ratings for doctors, specialists and

overall health care

Satisfaction with plan for children• Members report high ratings for the plan’s customer

service and the plan overall

Performance areas

Amerigroup Washington

Coordinated Care of Washington

Community Health Plan of Washington

Molina Healthcare of Washington

United Healthcare Community Plan

Getting care

Keeping kids healthy

Keeping women and mothers

healthy

Preventing and managing illness

Ensuring appropriate care

Satisfaction of care provided to

children

Satisfaction with plan for children

16

You have the responsibility to:• Help make decisions about your health care, including

refusing treatment.• Keep appointments and be on time. Call your

provider’s office if you are going to be late or if you have to cancel the appointment.

• Give your providers information they need to get paid for providing services to you.

• Show your providers the same respect you want from them.

• Bring your services card and health plan ID card to all of your appointments.

• Learn about your health plan and what services are covered.

• Use health care services when you need them.• Know your health problems and take part in making

agreed-upon treatment goals as much as possible.• Give your providers and health plan complete

information about your health so you can get the care you need.

• Follow your provider’s instructions for care that you have agreed to.

• Use health care services appropriately. If you do not, you may be enrolled in the Patient Review and Coordination Program. In this program, you are assigned to one primary care provider, one pharmacy, one prescriber for controlled substances, and one hospital for non-emergent care. You must stay in the same plan for at least 12 months.

• Inform us right away if your family size changes (such as pregnancy, births, adoptions) or your circumstances change (such as a new address, change in income, or becoming eligible for Medicare or other insurance).

• Renew your coverage annually using the Washington Healthplanfinder website at wahealthplanfinder.org . You also can use this website to report changes to your account.

Your rights and responsibilities

By law, you have rights regarding the health care services you receive, and you also have certain responsibilities to help maintain and improve your health and avoid unnecessary costs. It is possible to lose your health plan. This might happen if you don’t keep your provider appointments, don’t cooperate with your providers, and other reasons. Please contact us if you would like more information.

You have the right to:• Help make decisions about your health care, including

refusing treatment.• Be informed about all treatment options available,

regardless of cost.• Get a second opinion from another provider in your

health plan.• Get services without waiting too long.• Be treated with respect and dignity. Discrimination is

not allowed. No one can be treated differently or unfairly because of their race, color, national origin, gender, sexual preference, age, religion, creed, or disability.

• Speak freely about your health care and concerns without any bad results.

• Have your privacy protected and information about your care kept confidential.

• Ask for and get copies of your medical records.• Ask for and have corrections made to your medical

records when needed.• Ask for and get information about:

Ů Your health care and covered services. Ů Your provider and how referrals are made to

specialists and other providers. Ů How the health plan pays your providers for your

physical and behavioral health care. Ů All options for care and why you are getting certain

kinds of care. Ů How to get help with filing a grievance or complaint

about your care. Ů Your health plan’s organizational structure including

policies and procedures, practice guidelines, and how to recommend changes.

• Receive your Member’s Rights and Responsibilities in writing at least yearly. Your rights include mental health and substance use disorder treatment services.

• Receive a list of crisis phone numbers.• Receive help completing mental or medical health

advance directive forms.

If you’re unhappy with your health plan

You or your Authorized Representative have the right to file a grievance. A grievance is a spoken or written complaint regarding your quality of care or how you were treated by your doctor or health plan. Once a grievance is filed:

• Your health plan must let you know by phone or letter within two working days that it received your grievance.

• Your concerns must be addressed as quickly as possible, not taking more than 45 days.

Your health plan must help you file a grievance.

www.wahealthplanfinder.org

17

Where to get answers to your questions

If you’re unhappy with a medical decision your health plan madeYou or your Authorized Representative have the right to file an appeal. An appeal is a kind of complaint you make when you want your health plan to review a decision they made about coverage or payment of a covered medical service.

• Your plan will notify you in writing of their decision. Ifyou want to appeal their decision, the health plan willinclude documents on how to file an appeal.

• Your health plan must let you know in writing within 5days that it received your appeal.

• Your concerns must be addressed as quickly aspossible, not taking more than 28 calendar days.

Your health plan must provide you written notice of their decision and help you file an appeal.

Is it urgent? If you are appealing a decision and have an urgent physical or behavioral health condition, you or your provider can ask for an expedited (quick) review or hearing. If your medical condition requires it, a decision will be made about your care within three calendar days. Refer to your member handbook for more detailed information on these steps.

A note about privacyYour services card does not contain any personal information except your name, your ProviderOne number, and the issue date. This maintains your privacy if the card is lost or stolen. Neither the Health Care Authority (HCA), nor your health plan will ever contact you directly asking for your personal information to obtain or replace a services card. Never give your personal information, such as Social Security number, to someone who calls or emails you to ask for it.

By law, all health plans are required to protect your health information. Health plans and HCA use and share protected health information about you to provide your health benefits; to carry out treatment, payment, and health care operations; and for other reasons allowed and required by law. Health plans and HCA have the duty to keep your health information private.

To read HCA’s privacy policy, go to hca.wa.gov and click on “privacy” at the bottom of the page. If you want to read your health plan’s privacy policy, call your health plan’s member services or visit the plan’s website.

If you have any questions about Contact

• Changing health plans• Eligibility for health care

services• Services cards

• Apple Health Customer Service at 1-800-562-3022 or send your questions tohttps://fortress.wa.gov/hca/p1contactus/

• ProviderOne Client Portal: https://www.waproviderone.org/client

• Choosing a provider• Covered services• Your medical care• Your behavioral health care• Referrals to specialists• Health plan cards

Your health plan.Your health plan’s phone number is listed on page 5 of this booklet.

Changes to your account, such as: income, marital status, pregnancy, births, or adoptions.

Coverage for children, pregnant individuals, single adults, and parents/caretakers:• Online: wahealthplanfinder.org or• Call 1-855-923-4633 (TTY/TDD users call 1-855-627-9604)Coverage for individuals who are aged, blind, or disabled or in need oflong-term services and supports:• Visit your DSHS Customer Service Office (CSO) or

go to Washington Connections washingtonconnection.org

www.hca.wa.govwww.wahealthplanfinder.orgwww.washingtonconnection.org

18

Useful web pages

Web page URL

Washington Apple Health (Medicaid) website

hca.wa.gov/apple-health

Request Non-Emergency Medical Transportation

hca.wa.gov/transportation-help

Recovery Help Line waRecoveryHelpLine.orgIf you need treatment, call the 24-hour, free and confidential line 1-866-789-1511 (TTY 1-206-461-3219).

HCA is committed to providing equal access to our services. If you need an accommodation, or require documents in another format or language, please call 1-800-562-3022 (TRS: 711).

List your providers below, so you have the information available when you call for assistance.

Name and location Phone number

Doctor

Specialist

Specialist

Specialist

Pharmacy

Pharmacy

Hospital

Counselor

www.hca.wa.gov/apple-healthwww.hca.wa.gov/transportation-helpwww.warecoveryhelpline.org

P.O. Box 42719Olympia, WA 98504-2719HCA 19-046 EN (11/20) English

Documents

Welcome to Washington Apple Health Integrated Managed …[Romanian] Serviciile de asistență lingvistică, inclusiv cele de interpretariat și de traducere a materialelor imprimate,